If you enrolled in Medicare and noticed your Part B or Part D bill is higher than what your neighbor pays, you may have received an IRMAA notice. IRMAA stands for Income-Related Monthly Adjustment Amount, and it is a surcharge the federal government adds to your Medicare premiums when your income crosses a certain threshold. As of 2026, that threshold starts at $109,000 for single filers and $218,000 for married couples filing jointly. The extra charge can range from $81.20 to $487.00 per month for Part B alone, which adds up fast.
Quick Answer: IRMAA is the Medicare premium surcharge that applies to higher-income beneficiaries. In 2026, it kicks in at $109,000 (single) or $218,000 (joint) and is based on your 2024 tax return. You can appeal if your income dropped significantly since then.
This guide explains exactly how IRMAA works in 2026, how much it costs at each income tier, and what you can do if you think your surcharge is wrong.
What IRMAA Is and Why It Exists
Congress created IRMAA in 2003 as part of the Medicare Modernization Act. The idea: higher-income beneficiaries should pay a larger share of the actual cost of Medicare Part B coverage, which covers doctor visits, outpatient care, and durable medical equipment. In 2011, IRMAA was extended to Medicare Part D, the prescription drug coverage portion.
The standard 2026 Part B premium is $202.90 per month. That covers roughly 25% of what Part B actually costs. At higher incomes, the surcharge scales up so that beneficiaries pay 35%, 50%, 65%, 80%, or 85% of program costs depending on their income bracket. According to CMS, IRMAA affects roughly 8% of Medicare beneficiaries in any given year.
The surcharge is separate from your plan premium. It gets added on top of whatever your Part B or Part D plan costs, and it is typically collected by deducting it from your Social Security benefit each month.
How IRMAA Is Calculated in 2026
The Social Security Administration (SSA) determines your IRMAA using your Modified Adjusted Gross Income (MAGI) from two years prior. For 2026 IRMAA determinations, the SSA uses your 2024 federal tax return.
Your MAGI includes:
- Adjusted gross income (wages, self-employment income, pensions, IRA distributions, capital gains)
- Tax-exempt interest income (such as interest from municipal bonds)
It does not reduce for things like itemized deductions or standard deductions. One important note: Social Security benefits themselves may count toward your MAGI depending on your total income, per IRS guidelines.
The Cliff Effect
IRMAA does not work like a standard tax bracket where only income above the line gets taxed at the higher rate. It works like a cliff: if your 2024 MAGI is $1 over the threshold for a tier, you owe the full surcharge for that tier on every dollar of your premium. This is why careful income planning in the two years before Medicare enrollment can save thousands per year.
2026 IRMAA Brackets: Part B Surcharges
The table below shows the 2026 IRMAA brackets for Medicare Part B. The surcharge is added on top of the $202.90 standard monthly premium.
2026 Medicare Part B IRMAA Brackets (based on 2024 MAGI)
| MAGI: Single Filer | MAGI: Married Filing Jointly | Monthly Part B Premium | Monthly Surcharge Added |
|---|
| $109,000 or below | $218,000 or below | $202.90 | $0.00 |
| $109,001 to $137,000 | $218,001 to $274,000 | $284.10 | $81.20 |
| $137,001 to $171,000 | $274,001 to $342,000 | $405.80 | $202.90 |
| $171,001 to $205,000 | $342,001 to $410,000 | $527.50 | $324.60 |
| $205,001 to $499,999 | $410,001 to $749,999 | $649.20 | $446.30 |
| $500,000 or above | $750,000 or above | $689.90 | $487.00 |
Source: CMS 2026 Medicare Parts B Premiums and Deductibles fact sheet.
For a married couple where both spouses are on Medicare, the surcharge applies to each person individually. A couple in the second-highest tier would each pay $446.30 extra per month, a combined add-on of $892.60 per month on top of standard premiums.
2026 IRMAA Brackets: Part D Surcharges
If you have a Medicare Part D prescription drug plan, IRMAA adds a separate surcharge on top of your plan's own premium. The 2026 Part D IRMAA surcharges by income tier are:
2026 Medicare Part D IRMAA Surcharge (based on 2024 MAGI)
| MAGI: Single Filer | MAGI: Married Filing Jointly | Monthly Part D Surcharge |
|---|
| $109,000 or below | $218,000 or below | $0.00 |
| $109,001 to $137,000 | $218,001 to $274,000 | $14.50 |
| $137,001 to $171,000 | $274,001 to $342,000 | $37.50 |
| $171,001 to $205,000 | $342,001 to $410,000 | $60.40 |
| $205,001 to $499,999 | $410,001 to $749,999 | $83.30 |
| $500,000 or above | $750,000 or above | $91.00 |
Source: Social Security Administration 2026 IRMAA determination tables.
Unlike Part B IRMAA, which is deducted from your Social Security benefit, Part D IRMAA is billed by Medicare directly, separate from what you pay your drug plan. Even if your employer or retirement plan covers your Part D premium, you personally owe the IRMAA surcharge to Medicare.
Combined IRMAA Cost at Each Tier in 2026
To understand the real budget impact, here is what a single Medicare beneficiary pays in total monthly IRMAA surcharges (Part B plus Part D combined) at each income tier in 2026:
Combined 2026 IRMAA Surcharge Per Person (Part B + Part D)
| Income Tier (Single) | Monthly Part B Surcharge | Monthly Part D Surcharge | Total Monthly Add-On | Annual Extra Cost |
|---|
| Under $109,000 | $0.00 | $0.00 | $0.00 | $0 |
| $109,001 to $137,000 | $81.20 | $14.50 | $95.70 | $1,148 |
| $137,001 to $171,000 | $202.90 | $37.50 | $240.40 | $2,885 |
| $171,001 to $205,000 | $324.60 | $60.40 | $385.00 | $4,620 |
| $205,001 to $499,999 | $446.30 | $83.30 | $529.60 | $6,355 |
| $500,000 or above | $487.00 | $91.00 | $578.00 | $6,936 |
These are per-person figures. For a married couple where both are on Medicare, double the annual column.
How You Get Notified About IRMAA
The SSA mails an IRMAA determination letter to new Medicare enrollees and to existing beneficiaries whenever their income surcharge status changes. The letter arrives usually in November or early December for the following year's premiums.
The letter will include:
- Your 2024 MAGI as reported to the SSA by the IRS
- Which income tier you fall into
- Your new monthly Part B premium amount
- Instructions for appealing if your income has changed
If you are not already drawing Social Security benefits, Medicare will bill you directly for Part B rather than deducting it from a benefit check.
How to Appeal IRMAA: Step-by-Step
The 2026 IRMAA is based on 2024 income. If your income dropped significantly since 2024 (due to retirement, job loss, divorce, or another life change), you can request that the SSA use a more recent year's income instead. This is called an IRMAA appeal based on a life-changing event.
Life-Changing Events That Qualify
According to SSA, the following eight events qualify:
- Marriage
- Divorce or annulment
- Death of spouse
- Work stoppage (your own or a spouse's)
- Work reduction
- Loss of income-producing property
- Loss of pension income
- Receipt of employer settlement payment
A general income decline without one of these specific events does not qualify for an appeal under the life-changing event process. However, if the SSA used incorrect income data, you can dispute that separately.
Steps to Appeal IRMAA in 2026
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Gather documentation. Collect proof of the qualifying event (divorce decree, retirement letter, W-2s showing reduced income) and documentation of your current or projected income for a more recent tax year.
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Complete Form SSA-44. Download SSA Form SSA-44 ("Medicare Income-Related Monthly Adjustment Amount, Life-Changing Event") from ssa.gov.
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Submit within 60 days. File your appeal within 60 days of the date on your IRMAA determination letter. You can submit by mail, fax, or in person at your local SSA office.
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Request a reconsideration if denied. If the SSA denies your appeal, you have the right to request a hearing before an administrative law judge.
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Follow up. Processing takes 30 to 90 days on average. Keep copies of everything you submit.
Documents you will typically need:
- SSA-44 form (completed and signed)
- Most recent federal tax return showing reduced income
- Proof of the qualifying life-changing event (retirement letter, divorce decree, death certificate, etc.)
- Photo ID
Common reasons appeals are denied:
- No qualifying life-changing event occurred (general market loss or reduced investment income alone does not qualify)
- Insufficient documentation of income change
- Appeal filed more than 60 days after the IRMAA notice
- Projected income is still above the relevant threshold
SSA contact: Call 800-772-1213 (TTY: 800-325-0778), Monday through Friday, 8 a.m. to 7 p.m. local time.
How IRMAA Interacts With Medicare Advantage and Medigap
If you are enrolled in a Medicare Advantage (Part C) plan instead of Original Medicare, IRMAA still applies. Medicare Advantage plans replace Original Medicare's coverage, but your IRMAA surcharge for Part B is still collected by Medicare separately. You pay both the IRMAA and any Medicare Advantage plan premium.
If you have a Medigap (Medicare Supplement) policy, IRMAA also still applies. Medigap covers out-of-pocket costs for Original Medicare, but the surcharge is determined by Medicare, not by your Medigap insurer.
Strategies to Reduce Future IRMAA Exposure
Because IRMAA looks back two years, the income you report this year affects your 2028 Medicare premiums. A few approaches beneficiaries use:
Roth conversions in lower-income years. Converting traditional IRA funds to a Roth IRA counts as income in the year of conversion. If you do this in a year when your MAGI is already in a high IRMAA tier, timing matters less. If you plan ahead, spreading conversions over multiple lower-income years can keep each year's MAGI below the next tier threshold.
Qualified Charitable Distributions (QCDs). If you are 70.5 or older, you can direct up to $111,000 per year (2026 limit) from your IRA directly to a qualified charity as a QCD. The distribution counts toward your required minimum distribution but does not count as income in your MAGI calculation, per IRS Publication 590-B.
Harvesting losses in taxable accounts. Capital loss harvesting can offset capital gains and reduce your reported MAGI.
Delaying large one-time income events. Large IRA distributions, property sales, or business income two years before a Medicare start year can push you into a higher IRMAA tier. Planning those events carefully can make a multi-thousand-dollar difference.
These strategies involve tax planning and depend heavily on individual circumstances. A tax professional can help you model out the IRMAA implications before you make large financial moves.
Does the Medicare Savings Program Help With IRMAA?
The Medicare Savings Program (MSP) is a Medicaid-funded program that helps low-income Medicare beneficiaries pay their Part B premiums and, in some cases, cost-sharing. However, MSP is designed for people well below the IRMAA income thresholds. The highest MSP income limit in 2026 is roughly $20,000 to $27,000 for an individual depending on the state and MSP tier.
If you are subject to IRMAA, you are almost certainly above MSP income limits and would not qualify. The two programs serve very different income populations.
How to Check Your Own Medicare Coverage and Eligibility
If you are approaching Medicare eligibility or already enrolled and want to understand your full picture (Medicare, Medicare Savings Programs, Medicaid coordination), the CoveredUSA eligibility screener can help you identify every program you may qualify for in about two minutes.
Check your eligibility now at CoveredUSA. It takes 2 minutes.
See if you qualify at coveredusa.org/screener
You can also find more information on Medicare eligibility requirements at our Medicare eligibility guide.
Frequently Asked Questions
What is IRMAA in simple terms?
IRMAA is an extra monthly charge added to your Medicare Part B and Part D premiums if your income is above a certain level. In 2026, the surcharge begins when your 2024 income exceeded $109,000 for a single filer or $218,000 for a married couple filing jointly. It is not a penalty for anything you did wrong. It is simply the way Medicare is designed to have higher earners pay a larger share of program costs.
How much is the 2026 IRMAA surcharge?
In 2026, the Part B surcharge ranges from $81.20 to $487.00 per month per person, depending on income. The Part D surcharge adds $14.50 to $91.00 per month on top of that. A single beneficiary in the highest income tier pays up to $578.00 per month in combined IRMAA surcharges, or $6,936 per year.
Why is Social Security using my 2024 income for 2026?
The Social Security Administration uses tax data provided by the IRS. Because tax returns for a given year are not fully processed and available until the following year, SSA looks back two years. Your 2026 IRMAA is based on your 2024 MAGI because that is the most recent complete tax year available when SSA calculates your 2026 premiums.
Can I get IRMAA removed if I retired in 2025?
Yes, retirement is a qualifying life-changing event. If you retired in 2025 and your income dropped substantially, you can file Form SSA-44 with the SSA to request that they use your 2025 income (or your estimated current-year income) instead of your 2024 income. If approved, your surcharge can be reduced or eliminated starting the month your request is processed.
Is IRMAA based on total household income or individual income?
It depends on your tax filing status. If you file jointly, the SSA uses your combined household MAGI and applies the married-filing-jointly thresholds. If you file individually, only your own MAGI is used. Married couples who file separately face a different bracket structure that is significantly less favorable: the surcharge kicks in at the same income as single filers, not the joint threshold.
Does IRMAA apply to Medicare Advantage plans?
Yes. If you are enrolled in Medicare Advantage (Part C), you still pay the standard Part B premium plus any applicable IRMAA surcharge to Medicare. This is separate from whatever premium your Medicare Advantage plan charges. The IRMAA surcharge follows you regardless of what type of Medicare coverage you have.
How do I appeal IRMAA if my income went down?
File Form SSA-44 with the Social Security Administration within 60 days of your IRMAA determination letter. You will need documentation of the qualifying life-changing event that reduced your income (retirement letter, divorce decree, death certificate, etc.) plus evidence of your lower current or projected income. Call SSA at 800-772-1213 to start the process or visit your local SSA office.
Will IRMAA amounts change each year?
Yes. CMS adjusts IRMAA brackets annually for inflation, typically announcing the next year's amounts in November. The 2026 thresholds increased by approximately 3% compared to 2025. Because the brackets are inflation-adjusted, many beneficiaries stay within the same tier from year to year even as their income rises modestly with the cost of living.
